Transforming Aging in Brazilian Cities: A Case Study
By Antonio Nogueira Leitão, Instituto de Longevidade Mongeral Aegon
For many decades, the notion of being “the country of the future” has prevailed among Brazilians. Backed by a wealth of natural resources and the idea of a blossoming young population, this self-image has taken root and blossomed. Yet, the persistence of this vision of ourselves runs counter to our rapidly shifting demographic patterns.
Although still a relatively young country, Brazil is steadily growing older. From 1950 to 2015, life expectancy at birth increased from 50.8 to 74.6[1] years and the fertility rate declined from 6.1 to 1.6 children per woman. The cumulative effect of these trends becomes even more apparent when we compare the length of time it took for the 60+ populations of high-income countriers to double from 10% to 20% with that of Brazil: France made this change over a period of 145 years and Sweden in 89 years. Brazil is expected to do the same in just 25 years — between 2010 and 2035.
This transformation has its roots in the mid-20th century, when Brazil experienced a massive shift from rural to urban. Between 1950 and 2018, the urban concentration in Brazil exploded from 36.2% to a 86.6%. Among the most important factors that explain Brazil’s rapid aging are cultural changes, specifically in the societal role played by women, and the return to a democratic system in 1989 (following 25 years of military rule) and establishment of a welfare system that ensures access to healthcare, social security, and social assistance.
These many positive developments, however, do not prevent the country from facing great challenges. Brazilian women face high rates of domestic violence despite many achievements, and social welfare as a constitutional right is far from having erased inequity in society. As with other countries, aging, with its particular dynamics, adds several new layers of complexity to the governance of the system — the sustainability of social security being but one among many issues to tackle.
It is no secret that Brazil has high levels of regional socioeconomic diversity. Although a longstanding characteristic of Brazil’s economic development, this socioeconomic diversity was reinforced by the 1988 Constitution, the very same Constitution responsible for establishing the welfare system that makes of Brazil a “pro-aging” country, according to the World Bank.[2] The 1988 Constitution established three levels of government: federal, state, and municipal. The federal government determines what policies, particularly social policies, should be executed, and it is the municipal governments’ responsibility to implement these priorities.
Local capacity — from funding to skilled workforce availability — varies tremendously from municipality to municipality, creating barriers to successful policy implementation. Also, though not limited to Brazilian municipal governments alone, lack of coordination among different areas of public administration create silos that make effective policy implementation difficult. The scenario gets even worse when it comes to aging policy, since it is still widely regarded as a minor social issue. Aging is significantly underfunded, especially compared to other social issues, and it is highly impacted by lack of cross-sector coordination. For Brazil’s older population — whose concentration in urban areas equals more than 80% of its total — that means poorer experiences with public services. And for local public managers and servants, it points to the urgent need for more expertise and an innovative approach to aging.
When my colleagues and I at the Instituto de Longevidade Mongeral Aegon started to look at the challenge of aging and cities in Brazil, the first question we asked ourselves was, How can we precisely measure gaps in the implementation of local policies that support older adults? If we are to change the game in the aging field, a deep understanding of the reality of cities is a key element needed to drive these efforts. Out of this initial insight and the realization that Brazil had no specific metrics to assess a city’s readiness to promote active aging was born the first project of the Cities and Longevity Program: the Urban Development for Longevity Index (or IDL City Index).
Developed as a diagnostic tool, the IDL City Index gathers public data related to longevity standards from cities throughout Brazil. We collected indicator data in several key areas: Healthcare, Well-being, Finances, Culture and Engagement, Housing, Work and Education, and General. In the 2017 inaugural edition of the IDL City Index, we analyzed data from 498 cities from all over Brazil. While these cities account for just under 10% of Brazilian cities, they account for a full 60% of the total Brazilian population. Later this year, we plan to release the next installment of the City Index, this time with 1,000 cities evaluated.
Results from the first effort were little surprise: Brazilian cities are poorly prepared to promote and support active participation as our population ages. We ranked cities in the City Index according to an algorithmic score weighing indicators from each of the key areas we looked at. Aging readiness across Brazil mapped fairly closely with socioeconomic development in general. We found that regional disparities were significant, with high income areas accounting for most of the highly ranked cities in both development and aging readiness. Among the top 10 large cities, 8 are located in southeastern Brazil, and 2 are in southern states. Among the top 10 small cities, we found the same numbers, but the concentration was even greater, since all 8 southeastern cities are in the same state.
While Brazilians cannot solely rely on public managers to solve for this challenge, we also must recognize that there is no chance of real change that does not involve them. Accordingly, the next question we asked ourselves was, How can we engage local government on issues related to aging and increase capacity among local policy makers and public servants? If the IDL City Index seemed to be the right starting point for a conversation regarding the first matter, we did not have a tool to deepen that conversation and spread the word about planning for longevity in local governments.
Fortunately, at around the time we were posing this question to our team, Mr. Wesley Mendes da Silva, IDL City Index’s technical coordinator, introduced us to Ms. Cristiane Gattaz, a member of the Society for Design and Process Science. Ms. Gattaz accepted the challenge to develop a course modeled around Design and Process Science so that the diagnostics revealed by the Well-being metrics of the IDL City Index could be turned into transformative plans for cities.
This is how we came to develop and launch the Public Management for Longevity Training Course (GPL Training). During 2018, we delivered GPL Training in a partnership with Human Rights Ministry, which fully funded the project after a public call in which more than 200 proposals were analyzed. In total, 47 public managers — both public facing and behind-the-scenes civil servants — took part in the GPL Training, in many cases funding their transportation and housing expenses out of their own pockets.[3]
If the absence of financial support from city administrations for participation in the GPL Training showed us how big the challenge is before us in terms of awareness of aging in public management, at the same time, the great effort from participants confirmed the tremendous importance and value of the Cities and Longevity Program. In our short experience — Instituto de Longevidade Mongeral Aegon only began operations in 2016 — we are very proud of the achievements and are eager to move forward in promoting aging readiness in Brazil.
Antonio Nogueira Leitão is the Institutional Manager at the Instituto de Longevidade Mongeral Aegon. Aegon is a member of the Global Coalition on Aging.
[1]All data in the text were collected from the United Nations Department of Economic and Social Affairs (UNDESA).
[2]Growing old in an older Brazil: implications on population aging on growth, poverty, public finance, and service delivery.World Bank, 2011.
[3]No fee was charged for the course itself, thanks to a grant from the Human Rights Ministry.
